| Abdomen 2 views (74019) |
$357 |
$510 |
3.2× |
| Acute gi blood loss imaging (78278) |
$2,240 |
$3,200 |
5.3× |
| Angiography extremity bilateral rs&i (75716) |
$12,180 |
$17,400 |
3.7× |
| Angiography extremity unilateral rs&i (75710) |
$12,670 |
$18,100 |
3.8× |
| Angiography pelvic slctv/supraslctv rs&i (75736) |
$12,600 |
$18,000 |
2.1× |
| Angiography visceral slctv/supraslctv rs&i (75726) |
$3,150 |
$4,500 |
0.5× |
| Angrph Cath F-Up Std Tcat Other Than Thrombylsis (75898) |
$1,400 |
$2,000 |
0.4× |
| Ankle 2 views (73600) |
$245 |
$350 |
2.7× |
| Aortogram thoracic (75605) |
$3,570 |
$5,100 |
0.6× |
| Aortography abdl bi iliofem low extrem cath rs&i (75630) |
$11,340 |
$16,200 |
3.4× |
| Aortography abdominal serialography rs&i (75625) |
$11,760 |
$16,800 |
3.5× |
| Arthrogram elbow (73085) |
$1,330 |
$1,900 |
3.6× |
| Arthrogram hip (73525) |
$1,050 |
$1,500 |
2.9× |
| Arthrogram knee (73580) |
$1,330 |
$1,900 |
3.6× |
| Arthrogram shoulder (73040) |
$1,400 |
$2,000 |
3.8× |
| Arthrogram wrist (73115) |
$623 |
$890 |
1.7× |
| Bone &/Joint Imaging Limited Area (78300) |
$1,400 |
$2,000 |
3.3× |
| Bone &/Joint Imaging Multiple Areas (78305) |
$1,960 |
$2,800 |
4.6× |
| Bone &/joint imaging whole body (78306) |
$1,120 |
$1,600 |
2.7× |
| Bone age studies (77072) |
$420 |
$600 |
3.8× |
| Bone Imaging 3 Phase (78315) |
$1,190 |
$1,700 |
2.8× |
| Bone survey complete (77075) |
$1,190 |
$1,700 |
10.8× |
| Bone survey infant (77076) |
$1,050 |
$1,500 |
9.5× |
| Bowel imaging (78290) |
$1,820 |
$2,600 |
4.3× |
| Brain imaging < 4 static views (78600) |
$2,310 |
$3,300 |
5.5× |
| Brain Imaging < 4 Static Views W Vascular Flow (78601) |
$2,310 |
$3,300 |
5.5× |
| Brain Imaging Min 4 Static Views W Vascular Flow (78606) |
$3,010 |
$4,300 |
5.3× |
| Brain Imaging Vascular Flow Only (78610) |
$2,310 |
$3,300 |
4.0× |
| Brain imaging, minimum 4 static views; Non-Facility (78605) |
$2,310 |
$3,300 |
4.0× |
| Card Bl Pool Gated Spect Rest Wal Motn Ejct Frct (78494) |
$2,590 |
$3,700 |
6.1× |
| Card Bpi Gtd =Brm Plnr 1 Std Rest/Strs (78472) |
$1,890 |
$2,700 |
4.5× |
| Cardiac MRI w/w/o contrast & further seq (75561) |
$3,710 |
$5,300 |
10.1× |
| Cervical spine 2 or 3 views (72040) |
$490 |
$700 |
5.3× |
| Chest 1 view (71045) |
$287 |
$410 |
3.1× |
| Chest xray 3 views (71047) |
$420 |
$600 |
4.6× |
| Cine/Vid X-Ray Throat/Esoph - Fl Esoph Barium Swlw W/ Video & Speech (74230) |
$616 |
$880 |
3.3× |
| Clavicle complete (73000) |
$658 |
$940 |
7.2× |
| Contrast Xray Throat/Cerv Esopha (74210) |
$371 |
$530 |
2.0× |
| CT abdomen and pelvis without and with contrast (74178) |
$2,292.50 |
$3,275 |
6.2× |
| CT abdomen and pelvis without contrast (74176) |
$1,820 |
$2,600 |
7.2× |
| CT abdomen w contrast (74160) |
$1,750 |
$2,500 |
9.5× |
| CT abdomen w wo contrast (74170) |
$1,960 |
$2,800 |
10.6× |
| CT abdomen w/o contrast (74150) |
$1,540 |
$2,200 |
14.0× |
| CT angio hrt w/3d image (75574) |
$2,030 |
$2,900 |
5.5× |
| CT angio lwr extr w/o&w/dye (73706) |
$2,170 |
$3,100 |
11.7× |
| CT angiography upper extremity lt (73206) |
$1,890 |
$2,700 |
10.2× |
| CT c-spine w/contrast (72126) |
$2,450 |
$3,500 |
6.7× |
| CT c-spine w/o contrast (72125) |
$1,400 |
$2,000 |
12.7× |
| CT cervical spine w&w/o contrast (72127) |
$2,660 |
$3,800 |
14.4× |
| CT chest w contrast (71260) |
$1,750 |
$2,500 |
9.5× |
| CT chest w/wo contrast (71270) |
$1,960 |
$2,800 |
10.6× |
| CT head/brain with contrast (70460) |
$1,750 |
$2,500 |
9.5× |
| CT head/brain without and with contrast (70470) |
$1,960 |
$2,800 |
10.6× |
| CT heart contrast eval cardiac structure&morph (75572) |
$2,030 |
$2,900 |
5.5× |
| CT heart w/o contrast quant eval coronary calcium (75571) |
$329 |
$470 |
3.6× |
| CT hrt w/3d image congen (75573) |
$2,030 |
$2,900 |
5.5× |
| CT iac w contrast (70481) |
$1,750 |
$2,500 |
9.5× |
| CT limited/localized follow up study (76380) |
$1,540 |
$2,200 |
16.8× |
| CT lower ext w/o (73700) |
$1,540 |
$2,200 |
14.0× |
| CT lower extremity w wo contrast (73702) |
$2,590 |
$3,700 |
14.0× |
| CT lower extremity w/contrast material (73701) |
$2,380 |
$3,400 |
12.9× |
| CT lumbar spine w/contrast (72132) |
$1,750 |
$2,500 |
4.8× |
| CT lumbar spine w/o contrast (72131) |
$1,120 |
$1,600 |
10.2× |
| CT maxillofacial w contrast (70487) |
$1,750 |
$2,500 |
9.5× |
| CT maxillofacial w/wo contrast (70488) |
$2,030 |
$2,900 |
11.0× |
| CT maxillofacial wo contrast (70486) |
$1,540 |
$2,200 |
14.0× |
| CT orbit sella/post fossa/ear w/o & w/contr matr (70482) |
$1,960 |
$2,800 |
10.6× |
| CT orbits w/o contrast (70480) |
$1,540 |
$2,200 |
14.0× |
| CT pelvis w/o contrast (72192) |
$1,540 |
$2,200 |
14.0× |
| CT pelvis w/wo contrast (72194) |
$2,100 |
$3,000 |
11.3× |
| CT scan of arm combo (73202) |
$2,660 |
$3,800 |
14.4× |
| CT soft tissue neck w contrast (70491) |
$1,750 |
$2,500 |
9.5× |
| CT soft tissue neck w/o & w/contrast material (70492) |
$1,960 |
$2,800 |
10.6× |
| CT soft tissue neck w/o contrast (70490) |
$1,540 |
$2,200 |
14.0× |
| CT thoracic spine w/contrast (72129) |
$1,750 |
$2,500 |
9.5× |
| CT thoracic spine w/o contrast (72128) |
$1,750 |
$2,500 |
15.9× |
| CT thorax w/o contrast (71250) |
$1,190 |
$1,700 |
10.8× |
| CT unlisted procedure (76497) |
$980 |
$1,400 |
10.7× |
| CT upper ext wo (73200) |
$2,100 |
$3,000 |
19.0× |
| CT upper extremity with contrast (73201) |
$2,380 |
$3,400 |
6.5× |
| Cta Aa&Bi Iliofem Lxtr Rs&I C-/C+ Post-Pxessing (75635) |
$2,660 |
$3,800 |
14.4× |
| Cta Abdomen (74175) |
$2,310 |
$3,300 |
12.5× |
| CTA abdomen pelvis (74174) |
$1,960 |
$2,800 |
5.3× |
| CTA chest (71275) |
$1,960 |
$2,800 |
10.6× |
| Cta Head (70496) |
$1,960 |
$2,800 |
10.6× |
| Cta Neck (70498) |
$2,030 |
$2,900 |
11.0× |
| Cta Pelvis (72191) |
$2,590 |
$3,700 |
14.0× |
| Cystography minimum 3 views rs&i (74430) |
$1,120 |
$1,600 |
3.0× |
| Diskography lumbar (72295) |
$2,170 |
$3,100 |
1.1× |
| Dxa bone density study axial skeleton (77085) |
$175 |
$250 |
1.6× |
| Esophagus (74220) |
$511 |
$730 |
2.8× |
| Facial bones min 3 views (70150) |
$518 |
$740 |
4.7× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) |
$567 |
$810 |
5.1× |
| Fluoroscopy up to 1 hr (76000) |
$770 |
$1,100 |
3.1× |
| Foot 2 views (73620) |
$210 |
$300 |
2.3× |
| Forearm 2 views (73090) |
$273 |
$390 |
3.0× |
| Gastric Emptyng Imag Std W/Sm Bwl Transit (78265) |
$525 |
$750 |
1.2× |
| Gstrc Emptng Imag Std W/Sm Bwl Col Trnst Mlt Day (78266) |
$693 |
$990 |
1.2× |
| Hand 2 views (73120) |
$238 |
$340 |
2.2× |
| Heart first pass single,planar (78481) |
$1,960 |
$2,800 |
3.4× |
| Hepatc Vngrph Wdg/Fr Hemodyn Eval Rs&I (75889) |
$6,160 |
$8,800 |
1.8× |
| Hepatobil Syst Imag Inc Gb W/Pharma Intervenj (78227) |
$1,610 |
$2,300 |
2.8× |
| Hepatobiliary syst imaging including gallbladder (78226) |
$1,260 |
$1,800 |
3.0× |
| Hysterosalpingogram (74740) |
$1,540 |
$2,200 |
6.1× |
| Joint Survey, Single View - Xr Joint Anteroposterior 2+ Joints (77077) |
$238 |
$340 |
2.2× |
| Kidney imaging morphology (78700) |
$1,750 |
$2,500 |
4.1× |
| Kidney Img Morphology Vascular Flow 1 W/O Rx (78707) |
$1,820 |
$2,600 |
3.2× |
| Kidney img morphology vascular flow 1 w/rx (78708) |
$1,680 |
$2,400 |
2.9× |
| Kidney Img Morphology Vascular Flow Multiple (78709) |
$1,820 |
$2,600 |
3.2× |
| Knee 3 views (73562) |
$280 |
$400 |
3.0× |
| Liver & spleen imaging static only (78215) |
$1,890 |
$2,700 |
4.5× |
| Liver imaging w/vascular flow (78202) |
$1,190 |
$1,700 |
2.1× |
| Lung perf&ventilat diferentl (78598) |
$1,890 |
$2,700 |
3.3× |
| Lung perfusion differential (78597) |
$1,890 |
$2,700 |
4.5× |
| Lung ventilation imaging (78579) |
$1,820 |
$2,600 |
4.3× |
| Lymphoscintigraphy (78195) |
$1,540 |
$2,200 |
2.7× |
| Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Non-Facility (73222) |
$2,065 |
$2,950 |
2.5× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Non-Facility (73219) |
$2,590 |
$3,700 |
7.0× |
| Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by… (73220) |
$2,467.50 |
$3,525 |
6.7× |
| MRA head w & w/o contrast (70546) |
$2,940 |
$4,200 |
8.0× |
| MRA head w/o contrast (70544) |
$1,855 |
$2,650 |
7.4× |
| MRA head with contrast (70545) |
$2,730 |
$3,900 |
7.4× |
| MRA neck w contrast (70548) |
$2,380 |
$3,400 |
6.5× |
| Mra Neck W/O &W/Contrast Material (70549) |
$2,723 |
$3,890 |
7.4× |
| MRA neck w/o contrast (70547) |
$1,981 |
$2,830 |
7.9× |
| MRI abdomen w/o & w/contrast material (74183) |
$2,205 |
$3,150 |
6.0× |
| MRI abdomen w/o contrast (74181) |
$1,872.50 |
$2,675 |
7.4× |
| MRI any jt lower extrem w/contrast material (73722) |
$2,240 |
$3,200 |
2.7× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) |
$2,660 |
$3,800 |
7.2× |
| MRI bone marrow blood supply (77084) |
$3,710 |
$5,300 |
14.7× |
| MRI c-spine with contrast (72142) |
$2,730 |
$3,900 |
7.4× |
| MRI cardiac w/o contrast (75557) |
$3,710 |
$5,300 |
14.7× |
| MRI cervical spine w/o contrast (72141) |
$1,592.50 |
$2,275 |
6.3× |
| MRI chest w/o & w/contrast material (71552) |
$2,201.50 |
$3,145 |
6.0× |
| MRI chest w/o contrast (71550) |
$1,638 |
$2,340 |
6.5× |
| MRI chest with contrast (71551) |
$2,590 |
$3,700 |
3.1× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) |
$2,576 |
$3,680 |
7.0× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) |
$2,737 |
$3,910 |
7.4× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) |
$1,925 |
$2,750 |
7.6× |
| MRI orbit face &/neck w/o contrast (70540) |
$2,467.50 |
$3,525 |
9.8× |
| MRI orbit/face/neck w&w/o cont (70543) |
$2,667 |
$3,810 |
7.2× |
| MRI pelvis w/contrast (72196) |
$2,730 |
$3,900 |
7.4× |
| MRI pelvis w/o & w/contrast material (72197) |
$2,187.50 |
$3,125 |
5.9× |
| MRI pelvis w/o contrast (72195) |
$1,638 |
$2,340 |
6.5× |
| MRI spinal canal cervical w/o & w/contr matrl (72156) |
$2,485 |
$3,550 |
6.7× |
| MRI spinal canal lumbar w/contrast material (72149) |
$2,240 |
$3,200 |
6.1× |
| MRI spinal canal lumbar w/o & w/contr matrl (72158) |
$2,485 |
$3,550 |
6.7× |
| MRI spinal canal thoracic w/contrast matrl (72147) |
$2,730 |
$3,900 |
7.4× |
| MRI spinal canal thoracic w/o & w/contr matrl (72157) |
$2,467.50 |
$3,525 |
6.7× |
| MRI temporomandibular joint (70336) |
$3,220 |
$4,600 |
12.8× |
| MRI thoracic spine w/o contrast (72146) |
$2,187.50 |
$3,125 |
8.7× |
| MRI up ext w/o contrast (73218) |
$1,855 |
$2,650 |
7.4× |
| MRI upper ext joint w/o contrast (73221) |
$1,872.50 |
$2,675 |
7.4× |
| MRI, joint upper extrem combo (73223) |
$2,467.50 |
$3,525 |
6.7× |
| Myelogram Cervical (72240) |
$1,960 |
$2,800 |
2.4× |
| Myelogram Lumbar (72265) |
$3,430 |
$4,900 |
4.1× |
| Myelogram thoracic (72255) |
$3,080 |
$4,400 |
3.7× |
| Myelography 2 or more regions (72270) |
$2,380 |
$3,400 |
2.9× |
| Myocardial Perfusion Planar 1 Study Rest/Stress (78453) |
$5,110 |
$7,300 |
3.7× |
| Myocardial Spect Multiple Studies (78452) |
$3,010 |
$4,300 |
2.2× |
| Myocardial spect single study at rest or stress (78451) |
$5,250 |
$7,500 |
3.8× |
| Neck soft tissue (70360) |
$252 |
$360 |
2.7× |
| Nm cisternogram (78630) |
$3,010 |
$4,300 |
5.3× |
| Nm csf leak detection (78650) |
$1,400 |
$2,000 |
1.0× |
| Nm gastric emptying study (78264) |
$980 |
$1,400 |
2.3× |
| Nm kidney scan w/flow (78701) |
$1,610 |
$2,300 |
3.8× |
| Parathyroid Planar Imaging (78070) |
$910 |
$1,300 |
2.2× |
| Pelvis 1 or 2 views (72170) |
$294 |
$420 |
2.7× |
| Prq Transhepatc Portograpy Hemodyn Eval Rs&I (75885) |
$2,450 |
$3,500 |
0.7× |
| Pulmonary Perfusion Imaging Particulate (78580) |
$1,190 |
$1,700 |
2.8× |
| Pulmonary Ventilation & Perfusion Imaging (78582) |
$1,400 |
$2,000 |
2.4× |
| Radex abscess/fistula/sinus tract rs&i (76080) |
$1,680 |
$2,400 |
2.9× |
| Radex Ankle Compl Minimum 3 Views (73610) |
$308 |
$440 |
3.4× |
| Radex Calcaneus Minimum 2 Views (73650) |
$294 |
$420 |
3.2× |
| Radex Elbw Compl Minimum 3 Views (73080) |
$280 |
$400 |
3.0× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 1 Vw - Xr Scoliosis 1 Vw (72081) |
$126 |
$180 |
1.4× |
| Radex entir thrc lmbr crv sac spi w/skull 2/3 vw (72082) |
$182 |
$260 |
1.6× |
| Radex Entir Thrc Lmbr Crv Sac Spi W/Skull 4/5 Vw (72083) |
$350 |
$500 |
3.2× |
| Radex fingr minimum 2 views (73140) |
$231 |
$330 |
2.5× |
| Radex Foot Compl Minimum 3 Views (73630) |
$238 |
$340 |
2.6× |
| Radex Hand Minimum 3 Views (73130) |
$273 |
$390 |
3.0× |
| Radex Hip Unilateral With Pelvis 1 View (73501) |
$140 |
$200 |
1.5× |
| Radex Hip Unilateral With Pelvis Minimum 4 Views (73503) |
$182 |
$260 |
1.6× |
| Radex Hips Bilateral With Pelvis 2 Views (73521) |
$245 |
$350 |
2.2× |
| Radex Hips Bilateral With Pelvis Minimum 5 Views (73523) |
$350 |
$500 |
3.2× |
| Radex Humerus Minimum 2 Views (73060) |
$308 |
$440 |
3.4× |
| Radex Kne 1/2 Views (73560) |
$252 |
$360 |
2.7× |
| Radex Kne Compl 4/More Views (73564) |
$336 |
$480 |
3.0× |
| Radex Mndbl Compl Minimum 4 Views (70110) |
$1,330 |
$1,900 |
12.1× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) |
$448 |
$640 |
4.9× |
| Radex Pelvis Compl Minimum 3 Views (72190) |
$476 |
$680 |
4.3× |
| Radex Sho Compl Minimum 2 Views (73030) |
$357 |
$510 |
3.9× |
| Radex Sinuses Paransl < 3 Views (70210) |
$462 |
$660 |
5.0× |
| Radex Spine Lumbosacral Only Bending 2/3 Views (72120) |
$588 |
$840 |
5.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) |
$413 |
$590 |
4.5× |
| Radex Toe Minimum 2 Views (73660) |
$259 |
$370 |
2.8× |
| Radex upper extremity infant minimum 2 views (73092) |
$168 |
$240 |
1.5× |
| Radex Wrst Compl Minimum 3 Views (73110) |
$259 |
$370 |
2.8× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) |
$350 |
$500 |
3.2× |
| Radiologic Exam Abdomen 1 View - Xr Abdomen 1 View (74018) |
$343 |
$490 |
3.7× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) |
$840 |
$1,200 |
7.6× |
| Radiologic exam chest 2 views (71046) |
$357 |
$510 |
3.9× |
| Radiologic exam colon single contrast study (74270) |
$1,400 |
$2,000 |
7.6× |
| Radiologic Exam Esophagus Double Contrast Study (74221) |
$336 |
$480 |
1.8× |
| Radiologic exam upr gi trc double contrast study (74246) |
$518 |
$740 |
2.8× |
| Radiologic exam upr gi trc single contrast study (74240) |
$476 |
$680 |
2.6× |
| Radiologic examination femur 1 view (73551) |
$126 |
$180 |
1.4× |
| Radiologic Examination Salivary Gland Calculus (70380) |
$602 |
$860 |
6.6× |
| Radiologic examination tibia & fibula 2 views (73590) |
$350 |
$500 |
3.8× |
| Radiologic examination, internal auditory meati, complete Non-Facility (70134) |
$980 |
$1,400 |
1.7× |
| Radiological examination surgical specimen (76098) |
$280 |
$400 |
0.5× |
| Rp Loclzj Tum Plnr 1 Area Single Day Imaging (78800) |
$1,890 |
$2,700 |
4.5× |
| Rp loclzj tum plnr 2+area 1+d img/1 area img>2+d (78801) |
$1,470 |
$2,100 |
3.5× |
| Rp Loclzj Tum Plnr Whole Body 2+ Days Imaging (78804) |
$3,430 |
$4,900 |
6.0× |
| Rp loclzj tum plnr whole body single day imaging (78802) |
$2,520 |
$3,600 |
4.4× |
| Rp loclzj tum spect 1 area single day imaging (78803) |
$1,680 |
$2,400 |
2.9× |
| Sacroiliac Joints < 3 Views (72200) |
$210 |
$300 |
1.9× |
| Scapula (73010) |
$511 |
$730 |
4.6× |
| Screening Digital Breast Tomosynthesis Bi (77063) |
$91 |
$130 |
3.9× |
| Shoulder 1 view (73020) |
$315 |
$450 |
3.4× |
| Sialogram (70390) |
$602 |
$860 |
2.4× |
| Small bowel series (74250) |
$840 |
$1,200 |
4.5× |
| Spine thoracic 3 views (72072) |
$287 |
$410 |
2.6× |
| Thoracolumbar 2 views (72080) |
$399 |
$570 |
4.3× |
| Thyroid imaging w/blood flow (78013) |
$378 |
$540 |
0.9× |
| Thyroid uptake measurement (78012) |
$700 |
$1,000 |
1.7× |
| Thyroid Uptake W/Blood Flow Sngle/Mult Quan Meas (78014) |
$553 |
$790 |
1.3× |
| Ultrasound breast complete (76641) |
$350 |
$500 |
3.2× |
| Ultrasound Exam Aaa Screen (76706) |
$280 |
$400 |
2.5× |
| Ultrasound, abdomen limited (76705) |
$483 |
$690 |
4.4× |
| Unlisted gastrointestinal px dx nuclear medicine (78299) |
$910 |
$1,300 |
2.2× |
| Unlisted magnetic resonance procedure (76498) |
$2,100 |
$3,000 |
22.9× |
| Urethrocystogram voiding (74455) |
$1,680 |
$2,400 |
6.7× |
| Urethrocystography retrograde rs&i (74450) |
$1,050 |
$1,500 |
4.2× |
| Urography, infusion, drip technique and/or bolus technique; Non-Facility (74410) |
$1,820 |
$2,600 |
9.8× |
| Urography, infusion, drip technique and/or bolus technique; with nephrotomography Non-Facility (74415) |
$2,170 |
$3,100 |
11.7× |
| Us breast unilateral limited (76642) |
$280 |
$400 |
3.0× |
| Us chest (76604) |
$840 |
$1,200 |
7.6× |
| Us Cmprn Rpr Artl Pseudoarysm/Arven Fstl (76936) |
$840 |
$1,200 |
3.7× |
| Us compl joint r-t w/image documentation (76881) |
$581 |
$830 |
5.3× |
| Us encephalogram (76506) |
$840 |
$1,200 |
7.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) |
$336 |
$480 |
3.0× |
| Us nrv&acc strux 1 xtr compre w/img pr extremity (76883) |
$770 |
$1,100 |
7.0× |
| Us ob detailed single fetus (76811) |
$1,750 |
$2,500 |
6.9× |
| Us ob limited (76815) |
$770 |
$1,100 |
7.0× |
| Us ob transvaginal (76817) |
$770 |
$1,100 |
7.0× |
| Us pelvic non ob complete (76856) |
$609 |
$870 |
5.5× |
| Us pelvic nonobstetric image dcmtn limited/f/u (76857) |
$455 |
$650 |
4.1× |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) |
$910 |
$1,300 |
8.2× |
| Us pg uter r-t img f-up tabdl appr pr fetus (76816) |
$364 |
$520 |
3.3× |
| Us retroperitoneal complete (76770) |
$623 |
$890 |
5.6× |
| Us retroperitoneal limited (76775) |
$406 |
$580 |
3.7× |
| Us scrotum and contents (76870) |
$609 |
$870 |
5.5× |
| Us soft tissue head/neck (76536) |
$644 |
$920 |
5.8× |
| Us spinal canal and contents (76800) |
$1,120 |
$1,600 |
10.2× |
| Us transrectal (76872) |
$1,190 |
$1,700 |
10.8× |
| Us,transplanted kidney, real time/ doppler (76776) |
$546 |
$780 |
4.9× |
| Venogram extremity bilateral (75822) |
$1,890 |
$2,700 |
1.1× |
| Venogram Extremity Unilateral (75820) |
$1,610 |
$2,300 |
1.0× |
| Venography caval inferior serialography rs&i (75825) |
$2,870 |
$4,100 |
0.9× |
| Venography caval superior serialography rs&i (75827) |
$4,410 |
$6,300 |
2.7× |
Venous sampling by catheter (75893)
unusually low: confirm this is the full procedure |
$2,450 |
$3,500 |
0.4× |
| Vertebral fracture assessment via dxa (77086) |
$112 |
$160 |
1.2× |
| Wrist 2 views (73100) |
$210 |
$300 |
2.3× |
| X-Ray Abdomen,Comp Acute Series - Xr Abdomen 2 Vws With Chest 1 View (74022) |
$525 |
$750 |
4.8× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) |
$462 |
$660 |
5.0× |
| X-Ray Colon Air Contrast - Fl Barium Enema Air Contrast (74280) |
$1,260 |
$1,800 |
6.8× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) |
$238 |
$340 |
2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) |
$161 |
$230 |
1.8× |
| X-Ray Exam Hips Bi 3-4 Views (73522) |
$196 |
$280 |
1.8× |
| X-ray exam of femur 2/> (73552) |
$161 |
$230 |
1.8× |
| X-ray eye for foreign body (70030) |
$185.50 |
$265 |
2.0× |
| X-Ray Facial Bones <3 Vw - Xr Facial Bones 1-2 Views (70140) |
$224 |
$320 |
2.4× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) |
$609 |
$870 |
6.6× |
| X-Ray Knee Bilat Standing - Xr Knees Anteroposterior Standing Bilat (73565) |
$238 |
$340 |
2.6× |
| X-ray leg, infant (73592) |
$245 |
$350 |
2.7× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) |
$287 |
$410 |
2.6× |
| X-Ray Lumbar Spine 6+ Vw - Xr Lumbar Spine 6+ Vws Including Bending (72114) |
$770 |
$1,100 |
7.0× |
| X-ray nose-rectum child f.b. (76010) |
$226.80 |
$324 |
2.5× |
| X-ray optic foramen (70190) |
$574 |
$820 |
6.2× |
| X-Ray Orbits - Xr Orbits Complete 4+ Views (70200) |
$1,190 |
$1,700 |
10.8× |
| X-ray retrograde pyelogram (74420) |
$1,610 |
$2,300 |
4.4× |
| X-Ray Ribs 2 Vw Unilat - Xr Ribs 2 Views Right (71100) |
$252 |
$360 |
2.7× |
| X-Ray Ribs, Chest 3+ Vw - Xr Ribs 2 Vws Lt W/ Chest Anteroposterior (71101) |
$294 |
$420 |
2.7× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) |
$770 |
$1,100 |
7.0× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) |
$469 |
$670 |
4.3× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) |
$336 |
$480 |
3.7× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) |
$595 |
$850 |
6.5× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) |
$693 |
$990 |
6.3× |
| X-Ray Skull <4 Vw - Xr Skull 1-3 Views (70250) |
$511 |
$730 |
4.6× |
| X-Ray Small Bowel Enteroclysis (74251) |
$1,540 |
$2,200 |
8.3× |
| X-Ray Spine One View - Xr Spine (72020) |
$420 |
$600 |
4.6× |
| X-Ray Sterno-Clavicluar Jt - Xr Sternoclavicular Joints 3+ Views (71130) |
$504 |
$720 |
5.5× |
| X-Ray Sternum 2+ Vw - Xr Sternum 2+ Views (71120) |
$511 |
$730 |
5.6× |
| X-Ray Thoracic Spine 2 Vw - Xr Thoracic Spine 2 Views (72070) |
$336 |
$480 |
3.0× |
| X-Ray Thoracic Spine 4 Vw - Xr Thoracic Spine Complete 4+ Views (72074) |
$840 |
$1,200 |
7.6× |
| Xr bone length studies (77073) |
$336 |
$480 |
3.0× |
| Xr c-spine 4 or 5 views (72050) |
$455 |
$650 |
4.1× |
| Xr c-spine 6 or more views (72052) |
$658 |
$940 |
6.0× |
| Xr chest 4+ views (71048) |
$840 |
$1,200 |
7.6× |